Ocular modeling methods and apparatus

ABSTRACT

A method and apparatus for modelling a lens ( 104 ) of an eye ( 100 ), comprising: measuring ( 302 ) the anterior shape of the eye&#39;s cornea ( 102 ); determining ( 304 ) direct optical measurements of at least one parameter of the cornea ( 102 ) of the eye ( 100 ) and at least one parameter of the lens ( 104 ) of the eye ( 100 ); determining ( 306 ) the refractive index of the cornea; correcting ( 308 ) the optical measurements to account for the effect of the refractive index of the cornea on the direct optical measurements; measuring ( 310 ) the aberration of the eye; calculating ( 312 ) the refractive index of the lens by combining the corrected measurements and the aberration; and further correcting ( 314 ) the optical measurements of the lens to account the effect of the refractive index of the lens on the direct optical measurements.

CLAIM OF PRIORITY

This application claims the benefit of priority under 35 U.S.C. §365 ofInternational Patent Application Serial No. PCT/EP2010/054051 filed onMar. 26, 2010, designating the United States of America, which in turnclaims the benefit of priority of U.S. Provisional Patent Application61/163,806, filed on Mar. 26, 2009 and U.S. Provisional PatentApplication 61/172,673, filed on Apr. 24, 2009, which PCT Applicationand U.S. Provisional Patent Applications are incorporated by referenceherein.

FIELD OF THE INVENTION

The technology described herein relates to ocular modeling.

BACKGROUND TO THE INVENTION

Ocular procedures often modify one or more structures of the eye, suchas the cornea, lens, or retina. Some procedures involve removing orreplacing one or more structures of the eye, or adding an implant. Forexample, lens replacement surgery involves removing a patient's existinglens and replacing it with a new lens. Some procedures, such as laservision correction surgery, do not remove or replace existing structuresof patient's eye, or add an implant to the eye, but rather re-shapeexisting structures. Regardless of the type of modification being made(e.g., removal, replacement, insertion, or alteration), the opticalperformance of the eye is altered by the alteration of the structures ofthe eye.

SUMMARY OF THE INVENTION

According to some aspects of the technology described herein withreference to the appended claims, apparatus and methods are described tofacilitate modeling of one or more structures of an eye. The structuresmay be the cornea, the lens, or any other structures of the eye.

According to the present invention there is provided a method ofmodelling a lens of an eye, the method comprising: measuring theanterior shape of the eye's cornea; determining direct opticalmeasurements of at least one parameter of the cornea of the eye and atleast one parameter of the lens of the eye; determining the refractiveindex of the cornea; correcting the optical measurements to account forthe effect of the refractive index of the cornea on the direct opticalmeasurements; measuring the aberration of the eye; calculating therefractive index of the lens by combining the corrected measurements andthe aberration; and further correcting the optical measurements of thelens to account the effect of the refractive index of the lens on thedirect optical measurements. The direct optical measurements may be madeusing topography or interferometery.

Preferably, the at least one parameter of the cornea of the eyecomprises at least one of cornea thickness, posterior cornea shape anddistance from the back of the cornea to the front of the lens and the atleast one parameter of the lens of the eye comprises at least one ofanterior lens shape, posterior lens shape, lens thickness and distancefrom back of lens to the retina. The refractive index (index ofrefraction) of the cornea may be determined using a refractometer.

Preferably, the refractive index of the cornea is determined bycombining direct optical measurements of the cornea of the eye. Theaberration may be measured using a refractometer. The refractive indexof the lens may be calculated by matching a composite refractive indexof the lens, and optical measurements of the lens to a total compositerefraction or total composite aberrometry from the eye.

The direct optical measurements may further comprise measurements of thetotal ocular refraction and aberration in the absence of the lens, thetotal volume of aqueous; or total refraction and aberration with fluidin the lens capsule and anterior chamber. The direct opticalmeasurements may further comprise a distance from the back of the corneato the retina of the eye, the distance measured in the absence of thelens of the eye. The direct optical measurements may further comprise avolume of aqueous. The direct optical measurements may further comprisethe aberration of the eye and a distance from the back of the cornea tothe retina in the absence of the lens of the eye measured with fluid inthe lens capsule and anterior chamber.

The refractive index of the cornea, the refractive index of the lens andthe anterior and posterior shape of the cornea and the lens may bemeasured using a laser array source comprising one or more lasers.Measuring the anterior shape of the eye's cornea may comprise: capturingone or more images of a pattern of laser spots generated on the anteriorsurface of the cornea by the laser array source; forming an averagedimage from the captured images; and comparing the averaged images tospacing and arrangement of the lasers of the laser array source.

Measuring the posterior shape of the cornea of the eye may comprise:capturing one or more images of a pattern of laser spots generated onthe posterior surface of the cornea by the laser array source; formingan averaged image from the captured images; and comparing the averagedimages to spacing and arrangement of the lasers of the laser arraysource.

Computing the anterior lens shape may comprise: capturing one or moreimages of a pattern of laser spots generated on the anterior surface ofthe lens by the laser array source; forming an averaged image from thecaptured images; and comparing the averaged images to spacing andarrangement of the lasers of the laser array source.

Computing the posterior lens shape may comprise: capturing one or moreimages of a pattern of laser spots generated on the posterior surface ofthe lens by the laser array source; forming an averaged image from thecaptured images; and comparing the averaged images to spacing andarrangement of the lasers of the laser array source. The refractiveindex of the lens may be determined using a difference image determinedusing the reflection of one laser spot appearing on the anterior of thelens and the corresponding spot appearing on the posterior of the lens.

The present invention further provides a method of determining anoptimum position for a replacement intraocular lens based on theeffective position of the natural lens, said natural lens having ananterior surface and a posterior surface, the method comprisingmodelling the anterior and posterior surfaces of the natural lens usingthe method of modelling a lens of an eye as set out above; extrapolatingthe anterior and posterior surfaces to cross points; and determining theoptimum position to line in the place joining said cross points.

The present invention further provides an alternative method ofdetermining an optimum position for a replacement intraocular lens basedon the effective position of the natural lens, said natural lens havingan anterior surface and a posterior surface, the method comprising:modelling the anterior and posterior surfaces of the natural lens usingthe method of modelling a lens of an eye as set out above; determiningthe diameter of the natural lens; extrapolating the anterior andposterior lens surfaces to the diameter; determining the arc length ofthe natural lens using said diameter; and determining the optimumposition to lie at the midpoint of the arc length.

The present invention further provides a further alternative method ofdetermining an optimum position for a replacement intraocular lens basedon the effective position of the natural lens, said natural lens havingan anterior surface and a posterior surface, the method comprising:approximating a best fit curve for the posterior surface using theanterior lens surface, lens thickness and a historical ratio between theanterior and posterior lens curvatures.

According to the present invention there is also provided an apparatusfor modelling a lens of an eye, the apparatus comprising: means formeasuring the anterior shape of the eye's cornea; means for determiningdirect optical measurements of at least one parameter of the cornea ofthe eye and at least one parameter of the lens of the eye; means fordetermining the refractive index of the cornea; means for correcting theoptical measurements to account for the effect of the refractive indexof the cornea on the direct optical measurements; means for measuringthe aberration of the eye; means for calculating the refractive index ofthe lens by combining the corrected measurements and the aberration; andmeans for further correcting the optical measurements of the lens toaccount the effect of the refractive index of the lens on the directoptical measurements.

The means for determining the direct optical measurements may utilizetopography or interferometery. The at least one parameter of the corneaof the eye may comprise at least one of cornea thickness, posteriorcornea shape and distance from the back of the cornea to the front ofthe lens and wherein the at least one parameter of the lens of the eyemay comprise at least one of anterior lens shape, posterior lens shape,lens thickness and distance from back of lens to the retina. The meansfor determining the refractive index of the cornea may comprise arefractometer. The means for determining the refractive index of thecornea may comprise means for combining the direct optical measurementsof the cornea of the eye. The means for measuring the aberration of theeye may comprise a refractometer. The means for calculating therefractive index of the lens may be adapted to match a compositerefractive index of the lens, and optical measurements of the lens, to atotal composite refraction or total composite aberrometry from the eye.The direct optical measurements may further comprise measurements of thetotal ocular refraction and aberration in the absence of the lens, thetotal volume of aqueous; or total refraction and aberration with fluidin the lens capsule and anterior chamber. The direct opticalmeasurements may further comprise a distance from the back of the corneato the retina of the eye, the distance measured in the absence of thelens of the eye. The direct optical measurements may further comprise avolume of aqueous. The direct optical measurements may further comprisethe aberration of the eye and a distance from the back of the cornea tothe retina in the absence of the lens of the eye measured with fluid inthe lens capsule and anterior chamber.

The means for measuring the refractive index of the cornea, therefractive index of the lens and the anterior and posterior shape of thecornea and the lens may comprises a laser array source comprising one ormore lasers.

The means for measuring the anterior shape of the eye's cornea maycomprise: means for capturing one or more images of a pattern of laserspots generated on the anterior surface of the cornea by the laser arraysource; means for forming an averaged image from the captured images;and means for comparing the averaged image to spacing and arrangement ofthe lasers of the laser array source. The means for measuring theposterior shape of the cornea of the eye may comprise: means forcapturing one or more images of a pattern of laser spots generated onthe posterior surface of the cornea by the laser array source; means forforming an averaged image from the captured images; and means forcomparing the averaged image to spacing and arrangement of the lasers ofthe laser array source. The means for computing the anterior lens shapemay comprise: means for capturing one or more images of a pattern oflaser spots generated on the anterior surface of the lens by the laserarray source; means for forming an averaged image from the capturedimages; and means for comparing the averaged image to spacing andarrangement of the lasers of the laser array source. The means forcomputing the posterior lens shape may comprise: means for capturing oneor more images of a pattern of laser spots generated on the posteriorsurface of the lens by the laser array source; means for forming anaveraged image from the captured images; and means for comparing theaveraged image to spacing and arrangement of the lasers of the laserarray source.

The means for determining the refractive index of the lens may beadapted to use a difference image determined using the reflection of onelaser spot appearing on the anterior of the lens and the correspondingspot appearing on the posterior of the lens.

The present invention further provides an apparatus for determining anoptimum position for a replacement intraocular lens based on theeffective position of the natural lens, said natural lens having ananterior surface and a posterior surface, the apparatus comprising:means for modelling the anterior and posterior surfaces of the naturallens using the apparatus for modelling a lens of an eye of the presentinvention as set out above; means for extrapolating the anterior andposterior surfaces to cross points; and means for determining theoptimum position to line in the place joining said cross points.

The present invention further provides an apparatus for determining anoptimum position for a replacement intraocular lens based on theeffective position of the natural lens, said natural lens having ananterior surface and a posterior surface, the apparatus comprising:means for modelling the anterior and posterior surfaces of the naturallens using the apparatus for modelling a lens of an eye of the presentinvention as set out above; means for determining the diameter of thenatural lens; means for extrapolating the anterior and posterior lenssurfaces to the diameter; means for determining the arc length of thenatural lens using said diameter; and means for determining the optimumposition to lie at the midpoint of the arc length.

The present invention further provides an apparatus of determining anoptimum position for a replacement intraocular lens based on theeffective position of the natural lens, said natural lens having ananterior surface and a posterior surface; the apparatus comprising:means for modelling the anterior and posterior surfaces of the naturallens using the apparatus for modelling a lens of an eye of the presentinvention as set out above; and means for approximating a best fit curvefor the posterior surface using the anterior lens surface, lensthickness and a historical ratio between the anterior and posterior lenscurvatures. According to one aspect of the present invention, a methodof determining intraocular lens position is provided. The methodcomprises determining, using an interferometer, a first distance from ananterior surface of a cornea to an anterior surface of the lens. Themethod further comprises correcting the first distance to account for anrefractive index of the cornea to produce a second distance. The methodfurther comprises determining, using the interferometer, a thirddistance from the anterior surface of the lens to a posterior surface ofthe lens. The method further comprises correcting the third distance toaccount for an refractive index of the lens.

According to another aspect of the invention, a method is providedcomprising projecting an array of laser beams toward an ocular surfaceusing a laser array source, thereby producing a pattern of laser spotson the ocular surface. The method further comprises determining, atleast partially from the pattern of laser spots, an optical parameter ofthe ocular surface or an ocular material.

According to another aspect of the present invention, an apparatus isprovided, comprising a laser array source for producing a plurality oflaser beams, the laser array source configured to project the pluralityof laser beams onto a surface, the plurality of laser beams creating apattern of laser spots on the surface. The apparatus further comprises afirst imaging device and a second imaging device configured to captureimages of the pattern of laser spots. The first imaging device and thesecond imaging device are positioned approximately symmetrically aboutthe plurality of laser beams.

The present invention further provides at least one computer-readablestorage medium encoded with instructions that, when executed, perform amethod of determining, at least partially from a pattern of laser spotson an ocular surface, an optical parameter of the ocular surface or anocular material.

Accordingly, the present invention provides a method of determining thethree dimensional position and/or geometry of the natural lens and lensequator using direct or indirect measurements. The direct measurementsmay be used if the natural lens equator is accessible by either opticalor ultrasound methods and indirect measurements if natural lens equatoris not accessible by similar methods and correcting any measurements fordistortion as a result of different speed of light and sound indifferent medium for example refractive index in the case of opticalmethods and speed of sound in the case of ultrasound methods. Anyindirect measurements, for example, may include the measurement,computation and/or historical correlation of anterior lens curvature,posterior lens curvature, lens thickness and/or lens diameter to thethree dimensional position or geometry of natural lens equator. Anymeasurements using light methods may include using any combinations andpermutations of light technology including but not exclusively Purkinjeimaging, Scheimpflug imaging, interferometry, optical coherencetomography, aberrometry and/or refractometry.

It will be appreciated that position may be determined by measuring,either before or during surgery. These measurements may include a firstdistance from anterior surface of cornea to posterior surface of cornea;a second distance from posterior surface of cornea to anterior surfaceof lens; a third distance from anterior surface of lens to posteriorsurface of lens; a fourth distance from posterior surface of lens toanterior surface of retina and a fifth distance from anterior surface ofretina to posterior surface of retina.

When determining geometry, measurements including a first curvature ofanterior surface of cornea; a second curvature of posterior surface ofcornea; a third curvature of anterior surface of lens; a fourthcurvature of posterior surface of lens; and a fifth curvature ofanterior surface of retina; a sixth curvature of posterior surface ofretina may be taken.

It will be appreciated that these measurements will vary due to opticalabberations. The present invention may also include correcting fordistortions of any/all measurements and may include using historicalaverages or computing for speed of sound or refractive index using atleast one of the methods described above.

It will be appreciated that the present invention provides a method ofdetermining three dimensional intraocular lens position either before orduring surgery and any combination and permutation of the embodimentsdescribed. According to one embodiment, the method may compriseextrapolating the anterior and posterior surfaces to cross points anddetermining the optimum position to line in the place joining said crosspoints in a second embodiment, determining the diameter of the naturallens and extrapolating the anterior and posterior lens surfaces to thediameter, hence determining the arc length of the natural lens usingsaid diameter so as to determine the optimum position to lie at themidpoint of the arc length in a third embodiment, approximating a bestfit curve for the posterior surface using the anterior lens surface,lens thickness, a historical ratio between the anterior and posteriorlens curvatures and/or the diameter of the natural lens.

Determining the diameter of the natural lens may be performed beforesurgery and/or by injection of a fixed volume of fluid during surgery.Determining the posterior curvature of the lens and/or the distance fromthe posterior surface of the cornea to the posterior surface of the lensmay be performed before surgery specifically after removal of the lensfor example, if the lens is optically opaque.

It will be appreciated that the present invention may incorporatealtering predicted retinal image and may comprise some or all of theoptical methods described above; in addition to calculating coordinatesof light (image) source; calculating coordinates of light source at eachocular surface as it travel through successive interface; calculatingcoordinates at which light source arrives at the posterior surface ofthe retina in relation to the centre of the retina (fovea); altering anypermutation and combination of refractive index, distance and/orcurvature of lenses or any ocular surfaces to achieve a desired retinalimage.

As used herein, the optical parameter may be a shape of the ocularsurface. The optical parameter may also be the distance from one ocularsurface to another. The optical parameter may be an refractive index ofthe ocular material. The ocular surface may be a first ocular surface.Altering predicted retinal image may also comprise: focusing the arrayof laser beams approximately to a point on a second ocular surface whilethe pattern of laser spots is formed on the first ocular surface. Themethod may also comprise capturing a first image of the pattern of laserspots with a first imaging device and capturing a second image of thepattern of laser spots with a second imaging device The method may alsocomprise producing a combined image combining the first image and thesecond image. Determining, at least partially from the pattern of laserspots, an optical parameter, may comprise determining the opticalparameter at least partially from the combined image. The combined imagemay be an average of the first image and the second image, and whereinthe optical parameter may be a shape of the ocular surface. The combinedimage may be a difference of the first image and the second image, andwherein the optical parameter is an refractive index of the ocularmaterial. The first imaging device and the second imaging device may bepositioned approximately symmetrically about the array of laser beams.

The apparatus of the present invention may further comprise at least oneprocessor configured to receive output signals from the first imagingdevice and the second imaging device, and to process the output signalsto form a combined image representing a combination of a first image ofthe pattern of laser spots captured by the first imaging device and asecond image of the pattern of laser spots captured by the secondimaging device.

The at least one processor may comprise a first processor configured toreceive output signals from the first imaging device and a secondprocessor configured to receive output signals from the second imagingdevice, the first processor and second processor being communicativelycoupled to form the combined image.

The surface may be a first ocular surface, and the apparatus may furthercomprise an interferometer configured to determine a distance from thefirst ocular surface to a second ocular surface. The first and secondocular surfaces may be part of an eye, and wherein the apparatus mayfurther comprise a beam splitter positioned between the laser arraysource and the eye and also between the interferometer and the eye. Theinterferometer may be a single wavelength low or partial coherenceinterferometer. The first imaging device and the second imaging devicemay be fixed in place while capturing images of the plurality of laserspots. The first imaging device may be a CCD camera.

There is also provided a computer program comprising programinstructions for causing a computer program to carry out the abovemethod which may be embodied on a record medium, carrier signal orread-only memory.

It should be appreciated that all combinations of the foregoing conceptsand additional concepts discussed in greater detail below (provided suchconcepts are not mutually inconsistent) are contemplated as being partof the inventive subject matter disclosed herein. In particular, allcombinations of claimed subject matter appearing at the end of thisdisclosure are contemplated as being part of the inventive subjectmatter disclosed herein. It should also be appreciated that terminologyexplicitly employed herein that also may appear in any disclosureincorporated by reference should accorded a meaning most consistent withthe particular concepts disclosed herein.

BRIEF DESCRIPTION OF THE DRAWINGS

Various non-limiting embodiments of the technology described herein willnow be described with specific reference to the following figures. Itshould be appreciated that the figures are not necessarily drawn toscale.

FIG. 1 is a simplified schematic of an eye.

FIG. 2 illustrates a process sequence for developing a model of anocular structure, according to one embodiment of the invention.

FIG. 3 illustrates one non-limiting implementation of the process ofFIG. 2 to determine the shape and location of the front and backsurfaces of the cornea and the front and back surfaces of the lens,according to one embodiment of the present invention.

FIG. 4 illustrates an alternative non-limiting implementation of theprocess of FIG. 2 to determine the shape and location of the front andback surfaces of the cornea and the front and back surfaces of the lens,according to one embodiment of the invention.

FIG. 5 illustrates an apparatus comprising a laser array source formeasuring indices of refraction and shapes of ocular surfaces, accordingto one non-limiting embodiment of the invention.

FIGS. 6A-6E illustrate configuration of a laser array source andresulting patterns of laser spots on ocular surfaces, according to onenon-limiting embodiment of the invention.

FIGS. 7A-7E illustrate an alternative configuration of a laser arraysource compared to that of FIG. 6A, and the resulting patterns of laserspots on ocular surfaces, according to another non-limiting embodimentof the invention.

FIG. 8 illustrates one non-limiting implementation of the process ofFIG. 2 to determine the shape and location of the front and backsurfaces of the cornea and the front and back surfaces of the lens usingthe apparatus 500 of FIG. 5, according to one embodiment of theinvention.

FIG. 9 illustrates an alternative non-limiting implementation of theprocess of FIG. 2 to determine the shape and location of the front andback surfaces of the cornea and the front and back surfaces of the lensusing the apparatus 500 of FIG. 5, according to one embodiment of theinvention.

FIG. 10 illustrates various locations within a lens which may bedetermined to be an “effective location” of the lens, according to oneembodiment of the invention.

DETAILED DESCRIPTION OF THE DRAWINGS

Apparatus and methods for modeling one or more structures of the eye aredescribed. The modeling may indicate the shape and/or location of thestructures of the eye, which may be determined using optical methods fordetermining one or more parameters of the ocular structure of interest,as well as of the structures preceding the ocular structure of interest.The one or more parameters may include shape, thickness, and refractiveindex.

The measurement of any one of shape, thickness and/or refractive indexof an ocular structure of interest may depend to some extent on thedirectional changes which light employed by the measurement techniqueundergoes while passing through any ocular structures preceding thestructure of interest. Thus, according to one aspect of the technology,measurements of shape, thickness, and/or refractive index of ocularstructures may be corrected to account for the dependence of themeasured values on the other parameters for that structure, as well ason any of the parameters of preceding structures.

According to another aspect, apparatus are provided for measuring theshape, thickness, and refractive index of ocular structures of interest.According to one embodiment, the apparatus includes distinct instrumentsfor measuring one or more of the parameters of interest. According toanother embodiment, an apparatus includes integrated functionality formeasuring the parameters of interest. According to one non-limitingembodiment, the apparatus includes a laser array which projects aplurality of laser beams onto an ocular structure of interest, thusforming a laser spot pattern. The distances between the laser spots ofthe laser spot pattern may be used to calculate one or more parametersof the structure, such as the shape and refractive index. According tosome embodiments, the apparatus also determines the thickness ofstructures of an eye using interferometry.

The aspects of the technology mentioned above, as well as additionalaspects, will now be described in greater detail. These aspects may beused individually, all together, or in any combination of two or more,as the technology is not limited in this respect.

As mentioned, according to one aspect of the technology describedherein, the shapes and locations of ocular structures may be determined,from which an accurate model of the eye may be made. The structures mayinclude the cornea, the lens, the retina, or any other structures ofinterest. The shape and location of a structure may be determined bydirect measurement of one or more parameters, including shape,thickness, and refractive index, and then correction of any measurementsto account for dependence on other parameters of the measured structureor on any parameters of other structures within the eye. An example isnow described in connection with FIG. 1.

FIG. 1 provides a simplified representation of an eye 100, including acornea 102, a lens 104, and a retina 106. These structures are arrangedbetween a front side 108 of the eye, where light enters, and a back side110 of the eye. Between the cornea 102 and the lens 104 is a volume ofaqueous 111. Between the lens 104 and the retina 106 is a volume ofvitreous gel 112. It should be appreciated that the eye 100 issimplified for purposes of illustration, and that eyes typically includemore features than those shown in FIG. 1.

As mentioned, modeling the eye 100 may involve determining the shape ofone or more surfaces of interest, such as the front surface 114 a of thecornea, the back surface 114 b of the cornea, etc. Topography, forexample Scheimpflug topography, is one technique that may be used todetermine the shapes of such surfaces. However, other methods, includingPurkinje imaging, interferometry and/or optical coherence tomography mayalso be used.

As also mentioned, modeling the eye 100 to provide locations of theocular structures may involve determining various distances within theeye. As shown, the cornea 102 has a thickness T1, between the frontsurface 114 a of the cornea and the back surface 114 b of the cornea,and lens 104 has a thickness T2, between the front surface 116 a of thelens and the back surface 116 b of the lens. The cornea and lens areseparated by a distance dl (i.e., the distance from the back surface 114b of the cornea and the front surface 116 a of the lens). The retina isseparated from the back surface 116 b of the lens by a distance d2. Suchdistances may be measured using interferometry, or other techniques, asthe various aspects described herein are not limited in this respect.

However, while topography and interferometry techniques may be used tomeasure shapes and distances of ocular structures, such directmeasurement techniques alone may not produce entirely accurate results.The light employed by such measurement techniques may undergodirectional changes induced by the varying indices of refraction of theocular structures (i.e., refractive index n1 of the cornea, refractiveindex n2 of the aqueous, refractive index n3 of the lens, and refractiveindex n4 of the vitreous gel), such that the results may not be accurateif not accounting for such directional changes. The concept is explainedwith reference to FIG. 1.

As shown, the rays R1 and R2, which may correspond to the light sourcesemployed in conventional topography and/or interferometry techniques,originate on the front side 108 of the eye 100, and terminate on theretina 106. They do not follow a straight path, but rather are bent asthey pass through the cornea 102, the aqueous 111, the lens 104, and thevitreous gel 112. The illustrated paths of rays R1 and R2 are simplifiedfor purposes of explanation, and may be different in practice, eitherinvolving more or fewer changes in direction than those shown, andchanges of different direction than those shown.

The directional changes of light employed by measurement techniques suchas topography and interferometry may thus influence the results of suchmeasurements. Applicant has appreciated that such direct opticalmeasurements of shape and thickness may be corrected for theirdependence on the path of light within the eye, to enable highlyaccurate determination of shapes and locations of ocular structures.

FIG. 2 illustrates a method of modeling ocular structures, according toone embodiment of the technology. The method 200 begins at 202 byselecting the structure of interest. The structure of interest may be acomplete structure (e.g., a lens) or a surface (e.g., the front of thelens). The method continues at 204 by selecting a parameter of interest.The parameter may be the shape, thickness, or refractive index of thestructure of interest. Any of these three parameters may be of interesteither as an ultimate result or as a means for determining otherparameters, or for both purposes. For example, the shape of the corneamay be of interest as an end result for modeling the cornea, but mayalso facilitate determination of the refractive index of the cornea.

Subsequently, at 206, the method 200 continues by measuring theparameter of interest. For example, if the parameter of interest isshape (e.g., the shape of the front surface of the lens), the shape maybe directly measured, for example using optical techniques, such astopography techniques, or in any other suitable manner.

As described generally above, depending on the type of measurementtechnique used for any given parameter, the directly measured value(s)of that parameter may not account for light path changes (e.g., due todiffering indices of refraction of adjacent structures) within the eye.Thus, accurate determination of a given parameter of interest mayinvolve correction of a measured value (or values) of that parameter toaccount for other parameters of the structure of interest and/orparameters of ocular structures preceding the ocular structure ofinterest. Thus, in the non-limiting example of FIG. 2, the measuredparameter from 206 is corrected at 208 for its dependence (if any) onother parameters of the selected structure of interest and/or anyparameters of the preceding ocular structures.

For example, the shape of the front surface of the lens may be directlymeasured at 206 using topography, or any other suitable technique, whichmeasurements may then be corrected at 208 to account for the shapes ofthe front and back surfaces of the cornea, the thickness T1 of thecornea, the distance d1 between the back surface of the cornea and thefront surface of the lens, and the indices of refraction of the cornea(n1) and the aqueous (n2).

It should be appreciated that a measured value from 206 may depend onone or more parameters whose values are not yet known at 208 (e.g., havenot yet been measured).

For example, the shape of the front surface 116 a of the lens 104 may bedirectly measured, and, depending on the measurement technique used, themeasured shape may depend on the refractive index n1 of cornea 102,which may not have been measured as of the time the method proceeds to208. Accordingly, the method 200 may be iteratively performed to correcta measured value's dependence on all parameters on which it depends,regardless of the order in which the various parameters are determined.A similar result may be achieved using an alternative to the method 200,in which correction may be performed at 214, as described below, ratherthan at 208, after all parameters have been measured. However, generallyspeaking, the corrections may be performed at various times during themethodology, and the various aspects described herein are not limited toperforming corrections of directly measured values at any particularact.

Next, at 210, a determination is made whether all the parameters ofinterest for the structure of interest have been determined. Forexample, performance of acts 204-208 may return the thickness of aparticular structure (e.g., of a lens), but it may still be desired todetermine the shape of the lens. Thus, if not all parameters for a givenstructure of interest have been determined, the method may return to204, where the next parameter of interest for the structure of interestmay be selected.

If, at 210, it is determined that all the parameters of interest havebeen determined for the structure of interest, the method proceeds to212, at which a determination is made whether all the structures ofinterest have been examined. If not, the method may return to 202, wherethe next structure (e.g., complete structure or surface) may beselected.

Once all the parameters of interest have been determined for all of thestructure(s) of interest, the parameters may be combined at 214 to forma model of the structures. In some embodiments, the model may indicatethe shapes and locations of the structures, although not all embodimentsare limited in this respect. The model produced at 214 may be used toassess the function of the structures, to predict any changes infunction that will be caused by modifications of the structures (e.g.,during surgery or otherwise), to predict the performance of ocularimplants (e.g., lens implants, corneal implants, etc.), to plan opticalsurgeries, or for any other reason, as the various aspects describedherein are not limited to using models of ocular structures for anyparticular purpose(s). Analysis of the optical performance of themodeled structures may be performed using ray tracing software, or inany other suitable manner.

As mentioned the method 200 may be iterative, with the number ofiterations depending in some non-limiting embodiments on the number ofstructures and/or the number of parameters of interest. In addition, asmentioned previously, it should be appreciated that the correctionperformed at 208 may rely on parameters not yet determined as of act208. Thus, correction of measured parameters may also, or alternatively,be performed during the combination of the parameters at 214, once allthe parameters of interest have been measured.

The method 200 may be applied to any one or more structures of the eye.Thus, while the non-limiting illustration of method 200 ends with theformation of a model of the eye at 214, it should be appreciated thatthis is one non-limiting end result of the method. Alternatively, themethod may be used to model only a single structure (e.g., a lens, or asurface of a lens), or in some situations, only to determine a singleparameter of interest for which the measured value(s) may depend onother parameters. For example, determination of the refractive index ofa lens may be the desired outcome, and only a subset of the acts ofmethod 200 may be performed to achieve an accurate value of therefractive index.

The method 200 may be implemented in various manners, and the variousaspects of the technology described herein applying method 200 are notlimited to utilizing the method in any particular manner. For example,any suitable combination of hardware and/or software may be employed toperform one or more of the acts of method 200.

According to some embodiments, separate instruments are used to measurethe various parameters of interest, i.e., separate instruments are usedto measure thicknesses/distances, the indices of refraction, and theshapes of the structure(s) of interest. For example, an interferometermay be used to measure the thicknesses/distances of interest, while atopographer (e.g., a Scheimpflug topographer, or any other suitable typeof topographer) may be used to measure the shape of a given structure,and a refractometer may be used to determine the indices of refractionof interest. Hardware, software, and/or manual calculations may beemployed to perform the corrections and determinations of method 200(i.e., acts 208, 210 and 212). For example, in one embodiment, theoutputs of the various instruments are sent to one or more processorsfor performing the corrections, determinations, and the combinations ofthe determined parameters.

Alternatively, according to other embodiments, the measurements ofparameters of interest may be performed using an apparatus configured tomeasure two or more of the parameters. According to one embodiment, anapparatus utilizes different instruments for measuring thethicknesses/distances of interest and for measuring the indices ofrefraction and the shape of ocular structures. In one non-limitingembodiment, an apparatus includes an interferometer for measuringthicknesses/distances, and a laser array with multiple imaging devices(e.g., cameras) to determine the shapes of surfaces and the indices ofrefraction of interest.

Regardless of the types and number of instruments used to measure theparameters of interest, the resulting parameters may be combined to forma model of the structures of interest using any combination of hardware,software, and/or manual calculations, or in any other suitable manner.

For example, according to one embodiment, ray tracing software (e.g.,Matlab from the MathWorks Inc., Natick, Mass.; Zemax Focus Software fromZemax, Tucson, Ariz.; Optimas from MediaCybernetics, Visual Basic, orany other suitable software) is used at 214 to combine the determinedparameters. Other techniques may also be employed.

As mentioned, the method 200 may be used to model any one or more ocularstructures, or to determine desired individual parameters of ocularstructures. However, for purposes of illustration, two non-limitingexamples of the application of method 200 to the modeling of the corneaand lens of an eye are now described. It should be appreciated that themethod 200 is not limited to these two implementations, and that otherimplementations are possible.

The methods of FIGS. 3 and 4 illustrate alternative implementations ofthe method 200 to model the shapes and locations of the front and backsurfaces of the cornea and lens. The differences between methods 300 and400 may arise from the types of information known and sought, and thusmay depend on the operative stage at which the methods are applied. Forexample, the method 300 of FIG. 3 may be applied at a pre-operativestage, while the method 400 may be applied at an intra-operative orpost-operative stage. However, the methods 300 and 400 are not limitedto being applied at any particular stage of an ocular procedure.

As mentioned, methods 300 and 400 relate to modeling the front and backsurfaces of the cornea and the front and back surfaces of the lens.Multiple parameters may therefore be measured in performing methods 300and 400, while others may be determined or calculated withoutmeasurement. As has been described with respect to FIG. 2, measuredparameters may subsequently be corrected for any dependence the measuredparameter has on other parameters. As has also been mentioned, whether ameasured value of a parameter depends on other parameters may depend onthe manner in which the measured value is measured, for exampleincluding the type of instrument used. For methods 300 and 400, it isassumed that measured shapes are measured using a topographer (e.g., aScheimpflug topographer, or any other suitable topographer), and thatmeasured thicknesses are measured using an interferometer (e.g., amultiple wavelength low or partial coherence interferometer). However,it should be appreciated that method 200 may be implemented in othermanners, and that methods 300 and 400 are merely two non-limitingexamples. It will be appreciated that shapes and distances may also bemeasured using one or more methods and is not restricted to instrumentsincluding Scheimpflug, Purkinje or time-flight principles (such astomographers or optical coherence tomographers).

As a preliminary matter, the method 300 involves measuring severalparameters of the eye, including: anterior cornea shape; corneathickness; posterior cornea shape; distance from the back surface of thecornea to the front surface of the lens; anterior lens shape; posteriorlens shape; lens thickness; distance from the back surface of the lensto the retina; and the total ocular refraction/aberration. As mentionedpreviously, method 300 assumes that measured shapes are measured using atopographer, and that measured distances/thicknesses are measured usingan interferometer. As a result of those measurement techniques, theabove-listed measured parameters may have the following dependencies.The measured cornea thickness may depend on the refractive index of thecornea. The measured posterior cornea shape may depend on the refractiveindex of the cornea, the anterior cornea shape, and the corneathickness. The measured distance from back surface of the cornea tofront surface of the lens may depend on the refractive index of thecornea. The measured anterior lens shape may depend on the refractiveindex of the cornea, the anterior cornea shape, the posterior corneashape, the cornea thickness, and the distance from the back of thecornea to the front surface of the lens. The measured posterior lensshape may depend on the refractive index of the cornea, the anteriorcornea shape, the cornea thickness, the posterior cornea shape, thedistance from the back surface of the cornea to the front surface of thelens, the anterior lens shape, the posterior lens shape, the lensthickness, the distance from the back surface of the lens to the retina,the total ocular refraction/aberration, and the refractive index of thelens. The measured lens thickness may depend on the refractive index ofthe cornea and the refractive index of the lens. The measured distancefrom the back surface of the lens to the retina may depend on therefractive index of the cornea and the refractive index of the lens.Thus, the method 300 accounts for these dependencies by suitablycorrecting the measured values.

It should be appreciated that, given the interdependency of several ofthe measured parameters in method 300, the method may be implemented inany suitable order. In addition, one or more acts of the method may beimplemented in parallel. However, for purposes of illustration, method300 provides one non-limiting example of a suitable ordering of acts andsub-acts. Briefly, the method involves measure parameters whose valuesdepend on the refractive index of the cornea. The refractive index ofthe cornea is then determined, and the previously measured parametersare corrected to account for their dependence on the corneal refractiveindex. The total ocular refraction or aberration may also be measured.Then, by suitably combining the corrected parameters and the totalocular refraction or aberration, the refractive index of the lens may bedetermined. With that information, the lens thickness, the shape of theposterior lens surface, and the distance from the back surface of thelens to the retina may be accurately determined. Two or more of thedetermined values may then be combined to model the cornea and lens. Aswith method 200, the methods 300 and 400 may be iterative, and are notlimited to performing any particular acts of the method first. Rather,various acts may be performed in parallel, or in any one of variousserial sequences. Thus, the ordering described is not limiting.

Referring to FIG. 3, the method 300 begins at 302 by measuring theanterior cornea shape, i.e., the shape of the front surface of thecornea. As previously mentioned, such measurements of shape in themethod 300 are presumed to be performed using a topographer, however notall embodiments are limited in this respect.

At 304, various parameters whose measured values depend on therefractive index of the cornea may be measured. In the non-limitingexample of FIG. 3, these include measuring the thickness of the cornea(at 305 a), measuring the posterior cornea shape (at 305 b), i.e., theshape of the back surface of the cornea, measuring the distance from theback surface of the cornea to the front surface of the lens (at 305 c),measuring the anterior lens shape (at 305 d), i.e., the shape of thefront surface of the lens, measuring the posterior lens shape (at 305e), i.e., the shape of the back surface of the lens, measuring thethickness of the lens (at 3050, and measuring the distance from the backsurface of the lens to the retina (at 305 g). While each of thesemeasured values may depend on the refractive index of the cornea in thenon-limiting example of method 300, one or more may also depend onadditional parameters. For example, the measured posterior lens shape,measured lens thickness, and measured distance from the back surface ofthe lens to the retina may also depend on the refractive index of thelens.

The refractive index of the cornea may be determined at 306. This may bedone in various ways. According to one embodiment, the refractive indexof the cornea is determined by direct measurement, for example using arefractometer (e.g., to determine the critical angle of total internalreflection of the cornea). For example, a refractometer operating by theprinciple of total internal reflection may provide a compositerefractive index of the cornea at yellow wavelengths. However, not allembodiments are limited to using this type of refractometer. Such ameasurement may be corrected for any dependence the measured value mayhave on the wavelengths of light used by the refractometer, as well asthe measured cornea thickness from 305 a, the measured posterior corneashape from 305 b, and the measured anterior cornea shape from 302.Alternatively, the corneal refractive index may be calculated bysuitably combining the measured cornea thickness from 305 a, themeasured posterior cornea shape from 305 b, and the measured anteriorcornea shape from 302. Alternatively, the refractive index of the corneamay be determined by using any two optical methods to independentlymeasure the corneal thickness, thus producing different measuredthickness values which may depend on the refractive index of the cornea,and then accounting for the differently measured thickness values. Byknowing the manner in which the two methods differ (e.g., utilizingdifferent wavelengths, etc.), the refractive index may be determinedfrom the differently measured thickness values. For example, accordingto one embodiment, the refractive index of the cornea may be determinedby measuring the corneal thickness with interferometry and withScheimpflug topography, and then accounting for the differences in themeasured corneal thickness values produced by these two instruments,which may operate at different wavelengths. From the different measuredthickness values at the different wavelengths, the refractive index maybe calculated. Thus, act 306 is not limited to any particular method ofdetermining the refractive index of the cornea. At 308, the measuredvalues from 304 may be corrected for their dependence on the refractiveindex of the cornea determined at 306, for example using the techniquesdescribed in: Navarro R. The Optical Design of the Human Eye: a CriticalReview. Journal Of Optometry. 2009; 2(1):3-18; Dubbelman M, van derHeijde G L, Weeber H A. The Thickness of the Aging Human Lens Obtainedfrom Corrected Scheimpflug Images. Optometry and Visual Science. 2001;78(6): 411-416; and Drexler W, Hitzenberger C K, Baumgartner A, Findl O,Sattmann H, Fercher A F. Investigation of dispersion effects in ocularmedia by multiple wavelength partial coherence interferometry. Exp. EyeRes. 1998; 66, 25-33, all of which are hereby incorporated herein byreference in their entireties. Other techniques are also possible.

As mentioned, some of the measured values from 304 may also depend onthe refractive index of the lens. According to the non-limiting exampleof method 300, the refractive index of the lens is calculated, ratherthan measured. To facilitate this computation, the total ocularrefraction/aberration may be measured at 310. This measurement may bemade using a refractometer (e.g., an ocular autorefractometer, aHartmann Schack abberometer, Talbot-Morie interferometer, or any othersuitable instrument), or any other suitable technique.

Subsequently, at 312, the refractive index of the lens may be computedby suitably combining the values from 302-310. Non-limiting examples oftechniques which may be used in this step include those described in:Dubbelman M, van der Heijde G L, Weeber H A. The Thickness of the AgingHuman Lens Obtained from Corrected Scheimpflug Images. Optometry andVisual Science. 2001; 78(6): 411-416; and Rosales P, Marcos S. PentacamScheimpflug quantitative imaging of the crystalline lens and intraocularlens. J Refract Surg. 2009 May; 25(5):421-8, which are herebyincorporated herein by reference in their entireties. Other techniquesmay also be used. According to some embodiments, the computed refractiveindex of the lens is a composite value of the refractive index of thelens, and may be computed by matching the composite refractive index ofthe lens, corrected posterior lens topography, and lens thickness to thetotal composite refraction or total composite aberrometry of the eyefrom 310.

Once the refractive index of the lens is known, those previouslymeasured values which have some dependence on the refractive index ofthe lens may be corrected. For example, at 314, the measured values from305 e, 305 f, and 305 g may be corrected for their dependence on therefractive index of the lens, for example using the techniques describedin Rosales P, Marcos S. Pentacam Scheimpflug quantitative imaging of thecrystalline lens and intraocular lens. J Refract Surg. 2009 May;25(5):421-8, which is hereby incorporated herein by reference in itsentirety, or any other suitable techniques.

It should be appreciated that acts 312 and 314 are inter-related, inthat the computation of the refractive index of the lens depends on thevalues measured at 305 e, 305 f, and 305 g, and yet the measured valuesfrom 305 e, 305 f, and 305 g depend on the refractive index of the lens.Therefore, iteration between acts 312 and 314 may be performed toprovide a desired level of accuracy. Method 300 is not limited to usingany particular number of iterations of acts 312 and 314.

Once all of the measured values have been corrected for theirdependencies on any other parameters of interest, the method may proceedto 316, at which the corrected values may be suitably combined todetermine the shapes and locations of the front and back surfaces of thecornea and lens. Ray tracing software, or any suitable combination ofhardware, software, and manual calculations may be used to perform thecombinations to determined the shapes and locations of the front andback surfaces of the cornea and lens.

The various computations and combinations in method 300 may be performedusing any suitable combination of hardware, software, and/or manualcalculations. For example, ray tracing software may be used to performone or more of the acts in method 300. Other implementations are alsopossible.

FIG. 4 illustrates an alternative non-limiting example of theapplication of method 200 to the determination of the front and backsurfaces of the cornea and the front and back surfaces of the lens. Themethod 400 is applied in an intra-operative or post-operative setting,and thus at a different stage than the method 300, which illustrated apre-operative setting. For example, the method 400 may be applied when apatient's lens is to be replaced, therefore involving removal of thelens.

As with the method 300, method 400 presumes that measured shapes aremeasured using a topographer, and that measured distances/thicknessesare measured using an interferometer. It will be appreciated that shapesand distances may also be measured using one or more methods and is notrestricted to instruments including Scheimpflug, Purkinje or time-flightprinciples (such as tomographers or optical coherence tomographers).Thus, as with method 300, many of the values measured in method 400 maydepend on other parameters. For example, method 400 involves measuringthe following: anterior cornea shape; cornea thickness; posterior corneashape; distance from the back surface of the cornea to the front surfaceof the lens; anterior lens shape; lens thickness; distance from the backsurface of the lens to the retina; total ocular refraction andaberration in the absence of the lens; distance from the back surface ofthe cornea to the retina in the absence of the lens; total volume offluid in the lens capsule and anterior chamber (described below); totalrefraction and aberration with fluid in the lens capsule and anteriorchamber; and the distance from the back of the cornea to the retina withfluid in the lens capsule and the anterior chamber. Alternativelyseveral of the instruments mentioned above may be used to measure theposterior curvature of the lens in the absence of the lens.

As has been mentioned, the measurement of various parameters may produceresults which depend on one or more other parameters, for example as aresult of the measurement technique employed. Thus, one or more of theabove-mentioned measured values in method 400 may depend on one or moreother parameters. For example, the measured cornea thickness may dependon the refractive index of the cornea. The measured posterior corneashape may depend on the refractive index of the cornea, the anteriorcornea shape, and the cornea thickness. The measured distance from theback surface of the cornea to the front surface of the lens may dependon the refractive index of the cornea. The measured anterior lens shapemay depend on the refractive index of the cornea, the anterior corneashape, the cornea thickness, the posterior cornea shape, and thedistance from the back surface of the cornea to the front surface of thelens. The measured lens thickness may depend on the refractive index ofthe cornea and the refractive index of the lens. A measured value of therefractive index of the cornea may depend on the wavelength used tomeasure the cornea thickness, the anterior cornea shape, the corneathickness, and the posterior cornea shape. A measured value of thedistance from the back surface of the cornea to the retina after removalof the lens may depend on the refractive index of the cornea. Measuredvalues of the total ocular refraction and aberration, and the distancefrom the back surface of the cornea to the retina, as well as thedistance from the back of the lens to the retina with fluid in the lenscapsule and anterior chamber (described below) may depend on therefractive index of the cornea, the measured volume of fluid in the lenscapsule and anterior chamber, and the refractive index of this fluid.Measured values of the posterior lens shape may depend on the anteriorcornea shape, the cornea thickness, the posterior cornea shape, thedistance from the back surface of the cornea to the front surface of thelens, the anterior lens shape, the lens thickness, the distance from theback surface of the lens to the retina, the refractive index of thecornea, the total ocular refraction and aberration after lens removal,the distance from the back surface of the cornea to the retina afterlens removal, the volume of fluid inserted in the lens capsule andanterior chamber, the distance from the back surface of the lens to theretina with fluid in the anterior chamber, the total ocular refractionand aberration with fluid in the lens capsule and anterior chamber, thedistance from the back surface of the cornea to the retina with fluid inthe lens capsule and anterior chamber, the refractive index of the lens,and the refractive index of the fluid. Thus, method 400 may account forsuch dependencies.

The method 400 begins at 402 with the measurement of the anterior corneashape, i.e., the shape of the front surface of the cornea. At 404,measurements are made of those parameters whose values depend on therefractive index of the cornea in this non-limiting example. Thosevalues include measuring the thickness of the cornea (at 405 a),measuring the posterior cornea shape (at 405 b), measuring the distancefrom the back surface of the cornea to the front surface of the lens (at405 c), measuring the anterior lens shape (at 405 d), measuring thethickness of the lens (at 405 e), and measuring the distance from theback surface of the lens to the retina (at 405 f).

At 406, the refractive index of the cornea may be determined. This maybe determined in any suitable manner, including using any of thetechniques described previously for act 306 of method 300, or in anyother suitable manner. With the refractive index of the corneadetermined, method 400 may continue at 408 by correcting the measuredvalues from 404 for their dependence on the refractive index of thecornea, for example using techniques described in the previously citedreference to Rosales (Scheimpflug quantitative imaging of thecrystalline lens and intraocular lens), or any other suitabletechniques.

As mentioned, the method 400 may apply to a situation in which apatient's natural lens is to be removed (e.g., for replacement by animplant). Thus, at 410, several additional measurements are made,presuming that the lens has been removed. These measurements includemeasuring the total refraction, the total aberration, and the distancefrom the back surface of the cornea to the retina in the absence of thelens. Alternatively several of the instruments mentioned above may beused to measure the posterior curvature of the lens in the absence ofthe lens. These measurements may be made using any suitable techniques,as the method 400 is not limited in this respect.

As part of the lens replacement procedure, fluid may be inserted intothe lens capsule and/or the anterior chamber, after the patient'snatural lens has been removed. Measurements may be made with this fluidin place, and may provide additional data which may be utilized in themodeling procedure. In some embodiments, the fluid may have a knownrefractive index, although not all embodiments are limited in thisrespect. At 412, the volume of the fluid inserted in the lens capsulemay be measured, as well as the volume of the fluid inserted in theanterior chamber.

These volumes may be measured by using a graduated syringe, or in anyother suitable manner, as the method 400 is not limited in this respect.

Next, at 414, the measurements of 410 and 405 f may be repeated in thisnon-limiting example with the fluid in the lens capsule and anteriorchamber. Thus, the measurements at 414 may provide different resultsthan those initially made at 410 and 405 f if the fluid inserted intothe lens capsule and/or anterior chamber has a different refractiveindex than the refractive index of the patient's natural lens and/or theaqueous, for example. These differing values may provide additional datapoints which may be used in modeling.

At 416, the posterior lens shape and the refractive index of the lensmay be determined. These may determined in any suitable manner, such asby suitably combining two or more of the previously determined values.For example, the posterior lens shape may be determined by suitablycombining the anterior cornea shape, the values measured at 404, therefractive index of the cornea, the values measured at 410, the volumesdetermined at 412, the values measured at 414, the refractive index ofthe lens, and the refractive index of the fluid. Similarly, therefractive index of the lens may depend on the values determined priorto act 416, and therefore may be determined by suitably combining thesevalues, for example using techniques described in the previously citedreferences to Dubbelman (The Thickness of the Aging Human Lens Obtainedfrom Corrected Scheimpflug Images) and Rosales (Scheimpflug quantitativeimaging of the crystalline lens and intraocular lens), or any othersuitable techniques. In some embodiments, the volumes of fluid insertedinto the lens capsule and anterior chamber after removal of thepatient's lens may be approximately equal to the volumes of thepatient's lens and the aqueous, respectively. The determinations at 416may take any such relationship into account as appropriate.

At 418, method 400 continues by correcting the measured values from 405e and 405 f for their dependence on the refractive index of the lensdetermined at 416. This may be done using the techniques described inthe previously cited references to Dubbelman (The Thickness of the AgingHuman Lens Obtained from Corrected Scheimpflug Images) and Drexler(Investigation of dispersion effects in ocular media by multiplewavelength partial coherence interferometry), or any other suitabletechniques. Thus, it should be appreciated that acts 416 and 418 maydepend on each other, in that the determination of the refractive indexof the lens at 416 may depend on the lens thickness, and the distancefrom the back surface of the lens to the retina, while the measuredvalues of the lens thickness and the distance from the back surface ofthe lens to the retina may in turn depend on the refractive index of thelens. Thus, acts 416 and 418 may be iterated any number of times toprovide a desired degree of accuracy of the values determined by thoseacts. Subsequently, at 420, any two or more of the parameter valuesdetermined during method 400 may be combined to determine the shape andlocation of the front and back surfaces of the cornea and the lens. Aswith method 300, it should be appreciated that method 400 is onenon-limiting example of an order in which the acts illustrated may beperformed. However, other orders are also possible and one or more ofthe acts may be performed in parallel, as the method is not limited inthis respect.

While methods 300 and 400 illustrate non-limiting implementations of themethod 200 utilizing different instruments to measure distances, shapes,and indices of refraction, not all implementations of method 200 arelimited in this respect. For example, as previously mentioned, accordingto some embodiments, the method 200 may be implemented using anapparatus that integrates the functionality of an interferometer, atopographer, and a refractometer, or any other functions. According toone aspect of the technology described herein, an apparatus comprises alaser array source which may be used to measure surface shapes andindices of refraction. One non-limiting example of such an apparatus isillustrated in FIG. 5, together with the eye 100 of FIG. 1.

As shown, the apparatus 500 comprises a ray tracing apparatus 502. Theray tracing apparatus 502 comprises a laser array source 504, whichproduces an array of laser beams 505 a, 505 b, . . . , 505 n. Inaddition, the ray tracing apparatus 502 comprises a reference beamgenerator 506 for producing a reference point beam 507 (alternativelyreferred to herein as a “fixation laser”), and an interferometer source508 for producing an interferometry signal 509. Multiple imaging devices510 a and 510 b may also be included in the ray tracing apparatus 502.In addition, various optical components may be included fordirecting/controlling the various optical signals generated by theapparatus 502, such as an element 512 (which may in some situations be alens and/or a mirror, as described below) and beam splitters 514 a and514 b. It should be appreciated that other optical components may alsobe included, as the apparatus described herein are not limited to usingany particular optical components for directly/controlling opticalsignals. The apparatus 500 may further comprise one or more processors516 coupled to the apparatus 502 to receive and process signals from theapparatus 502. According to some embodiments, the processor 516 mayutilize ray tracing software, or any other suitable processingtechniques, as described further below. Although not shown, irisrecognition technology may optionally be included in the apparatus 502,for example to facilitate repeatability of measurements through thevisual axis.

The laser array source 504 may generate the array of laser beams 505 a .. . 505 n, which beams may be projected onto the eye 100. As describedin further detail below, the array may be controlled to be focused on aparticular surface of the eye if desired, although not all embodimentsare limited in this respect. The array of laser beams 505 a . . . 505 nmay generate a pattern of laser spots on each surface it contacts. Thespacing between the spots of the pattern may be used to determine theshape of the surface on which the pattern appears. Also, the spacingbetween the spots may be used to determine the refractive index of anocular material through which the laser beams 505 a . . . 505 n havepassed.

The laser array source 504 may comprise any number of laser beams 505 a. . . 505 n. An array with a larger number of beams may provide greateraccuracy in determinations of surface shapes and indices of refractionbased on a pattern of laser spots corresponding to the array. However,the various aspects described herein implementing an apparatus with alaser array source are not limited to using any number of laser beams.According to some embodiments, the laser array source 504 generates atleast twelve laser beams. According to one embodiment, the laser arraysource generates sixteen laser beams. According to some embodiments, thelaser array source may generate between 16-256 laser beams.

Again, the laser array source 504 is not limited to generating anyparticular number of laser beams.

The laser beams may have any suitable sizes (e.g., diameters) andcross-section shapes. According to one embodiment, the diameters of thelaser beams are as small as possible (e.g., as small as may bedetectable with the imaging devices 510 a and 510 b), which mayfacilitate inclusion of a larger number of beams in the array. However,the laser beams are not limited to having any particular diameters.According to some embodiments, the laser array may have a tight pointspread function. The laser beams may have a circular cross-section, anoval cross-section, a star-shaped cross-section, a hexagonalcross-section, or any other suitable cross-section. Thus, it should beappreciated that the lasers described herein are not limited to havingany particular cross-section shapes.

The laser beams 505 a . . . 505 n may have any suitable wavelengths. Aswill be described further below, some values of ocular parametersmeasured using a laser array may depend on the wavelengths of the lasersof the array, such that the measured values may be corrected to accountfor their dependence on the wavelengths. In addition, by utilizingmultiple wavelengths (e.g., a laser source having variable wavelengthlasers), additional data points at the various laser wavelengths may becollected, which may increase the accuracy of calculations of refractiveindex and shape using the laser array. For example, utilizing multiplewavelengths may enable production of a graph of refractive index as afunction of wavelength. According to some embodiment, the laser arraymay include lasers having infrared wavelengths, which may be used todetermine approximate values of surface temperatures of the ocularsurfaces on which the laser impinge. According to some embodiments, thearray of laser beams may comprise laser beams of two or more differentwavelengths (e.g., red and green wavelengths). However, the laser beams505 a . . . 505 n are not limited to having any particular wavelengths.According to some embodiments, the lasers have short pulses tofacilitate an increase in resolution of the laser array.

According to some embodiments, the array of laser beams may be scannedover the eye 100. In such embodiments, any suitable scan time may beused. Using a shorter duration scan time may reduce the impact of ocularmovement on the measurements utilizing the laser array.

According to one embodiment, the laser array source may be adjustable,for example allowing it to assume various angles with respect to the eye100. By projecting the laser beams onto the eye from various angles,additional data points may be collected compared to if the laser arraysource is fixed at a single location. According to some embodiments, thelaser array source and imaging devices may be positioned and angledaccording to Scheimpflug principles, although not all embodiments arelimited in this respect.

As mentioned, the array of laser beams 505 a . . . 505 n may be directedonto one or more surfaces of the eye 100, such as the front surface ofthe cornea, the back surface of the cornea, the front surface of thelens, the back surface of the lens, the retina, or any other surfaces,resulting in a pattern of laser spots on those surfaces. The element 512and the beams splitters 514 a and 514 b may be used to control whichsurfaces of the eye the laser beams 505 a . . . 505 n impact, andwhether the beams are focused on those surfaces or not. For example, theelement 512 may comprise a lens (e.g., an aspheric lens) for collimatingand/or converging the array of laser beams 505 a . . . 505 n, forexample to focus the array of laser beams to a single spot on one of theocular surfaces, as described further below. By focusing the array ondifferent surfaces of the eye, different data points may be collectedfor determining indices of refraction and shapes, as described below.The use of such additional data points may increase the accuracy of thedetermined values of the refractive index and shape. While element 512may comprise one or more lenses, it may alternatively, or in addition,comprise a mirror, which in some cases may be a deformable mirror, todirect the laser beams 505 a . . . 505 n.

The imaging devices 510 a and 510 b may be configured and used tocapture images of the pattern(s) of laser spots on one or more of theocular surfaces of eye 100 resulting from the array of laser beams 505 a. . . 505 n. According to one embodiment, the imaging devices 510 a and510 b may be positioned approximately symmetrically on opposite sides ofthe laser array (e.g., on right and left sides, top and bottom, etc). Insome embodiments, positioning the imaging devices symmetrically aboutthe laser array may result in the imaging devices being symmetricallypositioned about the laser array source. In addition, the imagingdevices 510 a and 510 b may be substantially equidistant from the eye100.

According to some embodiments, the imaging devices 510 a and 510 b maybe positioned according to Scheimpflug principles. While the imagingdevices 510 a and 510 b capture slightly different images of any patternof laser spots on the surfaces of the eye, as a result of imaging thepattern from different angles, the images captured by the two imagingdevices may be combined to determine shapes of ocular surfaces and/orindices of refraction of ocular materials.

According to one embodiment, averaging the images of a same pattern oflaser spots captured by imaging devices 510 a and 510 b may produce anaveraged image from which the shape of the surface on which the patternappears may be determined Such an averaged image may correspondsubstantially to the image that would be captured by a single imagerpositioned at the point of the laser array source 504, if it werepossible to position an imaging device there without having the laserarray source impede the field of view of the imaging device. The shapeof the surface may be determined from the averaged image by suitablyprocessing the distances between the laser spots of the averaged imageand comparing the distances in the averaged image to the separationdistances of the laser beams at the laser array source 504. According tosome embodiments, the distances between nearest neighbor spots are used.According to an alternative embodiment, the distance between a singlespot and every other spot of the array is used. Other techniques arealso possible. According to one embodiment, ray tracing software (e.g.,any of the types previously mentioned or any other suitable ray tracingsoftware) may perform such processing. According to another non-limitingembodiment, the techniques described in Preussner P, Wahl J, Kramann C.Corneal model. J Cataract Refract Surg 2003; 29:471-477, may be used andis incorporated herein by reference in its entirety.

According to one embodiment, taking a difference between the images of asame pattern of laser spots captured by imaging devices 510 a and 510 bmay produce a differenced image from which the refractive index of amaterial may be determined. For example, the differenced image may beproduced by subtracting the image captured by imaging device 510 a fromthe image captured by imaging device 510 b, or vice versa. According toone embodiment, the array of laser beams may be focused approximately toa point at a first location (e.g., on a first ocular surface), while thearray forms a pattern of laser spots at a second location (e.g., on asecond ocular surface). The refractive index of the material separatingthe first and second locations may be determined by knowing the distancebetween the first and second locations and then processing the distancesbetween laser spots of the pattern of laser spots in a differenced imageof the pattern at the second location. An example is described infurther detail below.

The imaging devices 510 a and 510 b may be any suitable type of imagingdevices. According to one embodiment, the imaging devices 510 a and 510b are CCD imagers. However, they may alternatively be CMOS imagers, orany other suitable types of imaging devices. According to someembodiments, the imaging devices 510 a and 510 b are fixed, such thatthey do not move during operation of the apparatus 500. In this manner,the apparatus 500 may be simplified compared with systems that utilizerotating, or otherwise moving, cameras. According to some embodiments,the imaging devices may be light field cameras. Also, the imagingdevices may produce still frames or video images, as the various aspectsdescribed herein are not limited in this respect.

Also, the imaging devices 510 a and 510 b may have any suitableresolution. A higher resolution may provide greater accuracy indetermining locations of laser spots on the surfaces of the eye, andtherefore may be desirable in some embodiments. In addition, an imagingdevice with sufficiently high resolution may enable use of a magnifiedimage of a single reflected laser beam to serve as a proxy for the pointspread function or small particle light scattering value for thatreflected beam.

It should be appreciated that any number of imaging devices may be usedin various embodiments. For example, while FIG. 5 illustrates twoimaging devices, some embodiments may employ only a single imagingdevice which may rotate. According to other embodiments, between fourand sixteen imaging devices may be used. Other numbers are alsopossible. Using a larger number of imaging devices may enhance the speedat which data may be collected. The imaging devices may be positioned atany suitable distances and/or angles relative to each other and to aneye. According to one embodiment, an array of imaging devices (e.g.,including imaging devices 510 a and 510 b, as well as additional imagingdevices) may be positioned at more than one location or angle relativeto the eye, which may allow calculation of centration and triangulationof vectors of rays reflected by the eye. According to one embodiment,six imaging devices may be arranged in a substantially circularconfiguration. According to one embodiment, the apparatus 500 maycomprise an array of imaging devices, including imaging devices 510 aand 510 b, which array may be used to obtain aberrometry measurements.

The source 506 may be a refractometer, an aberrometer, or any othersuitable source for generating a suitable reference beam. The referencebeam may provide a reference point for the imaging devices 510 a and 510b, and may also, or alternatively, provide a patient a reference to lookat when interacting with the apparatus.

As mentioned, the ray tracing apparatus 502 further comprises aninterferometer source 508, which may be used to measuredistances/thicknesses of the eye 100. According to one embodiment, theinterferometer source 508 is a single wavelength low or partialcoherence interferometer, such that the interferometry signal 509 may bea single wavelength low or partial coherence interferometry signal.However, not all embodiments are limited in this respect, as, forexample, the interferometer source 508 may be a multiple wavelength lowor partial coherence interferometer. The interferometer source 508 maybe positioned so that the interferometry signal 509 is split by beamsplitter 514 b, with part of the split beam passing to the eye 100.Other configurations for the interferometer source 508 are alsopossible.

According to some embodiments the laser array source and/orinterferometer source may be configured so that measurements with theiroptical signals are centered on the visual axis of the eye 100.According to alternative embodiments, the laser array source and/orinterferometer source may be configured so that measurements with theiroptical signals are centered on the geometrical axis of the eye 100.Thus, it should be appreciated that various configurations are possible.

The processor 516 may be coupled to the ray tracing apparatus 502 via aconnection 518 to receive outputs from the ray tracing apparatus 502.The outputs may be outputs of the imaging devices 510 a and 510 b and/orof the interferometer source 508. The processor may perform any suitabletype of processing, such as producing the averaged images describedabove from imaging devices 510 a and 510 b, the differenced images fromimaging devices 510 a and 510 b, performing calculations of distancesbetween laser spots of a captured image, performing calculations todetermine indices of refraction, performing calculations to determineshapes of surfaces, performing calculations to determinedistances/thicknesses, or any other suitable types of processing.Accordingly, the processor 516 may be any suitable type of processor.According to some embodiments, more than one processor may be used.According to some embodiments, the processor may be integrated with theray tracing apparatus 502, while in other embodiments it may be adistinct device.

According to some embodiments, the processor 516 may also control theray tracing apparatus 502. For example, the processor may control theoperation of one or more of the reference beam source, the laser arraysource, and the interferometer source. The processor 516 may sendcommands or instructions to one or more of those components instructingthem how to behave. However, not all embodiments are limited to havingthe processor exhibit control functionality of the ray tracing apparatus502.

According to some embodiments, the processor 516 may operate ray tracingsoftware. According to some embodiments, the processor 516 may performany of the processing acts previously described with respect to method200, and in some embodiments may combine parameters of an eye to form amodel of one or more structures of the eye as an output 520. Theapparatus 500 and/or ray tracing apparatus 502 may be a stand alonedesktop type device in some non-limiting embodiments. According to otherembodiments, one or both may be a handheld device. According to stillother embodiments, one or both may be incorporated into an operatingmicroscope. Other configurations are also possible.

Some non-limiting examples of the operation of the array of laser beams505 a . . . 505 n are now described with respect to FIGS. 6A-6E and7A-7E. It should be appreciated that these are merely non-limitingexamples.

FIG. 6A illustrates a non-limiting example of a configuration of a laserarray with respect to the front and back surfaces of the cornea and lensof the eye 100. As shown, the laser array 605 comprises a plurality oflaser beams, in this non-limiting example thirteen (although not all arevisible from the perspective of FIG. 6A), which pass through acondensing lens 612 to the front surface 114 a of the cornea. The laserbeams then proceed to the back surface of the cornea 114 b, and arefocused approximately to a point on the front surface 116 a of the lens.The laser beams continue to the back surface 116 b of the lens. FIGS.6B-6E show the resulting patterns of laser spots (also referred toherein as “Purkinjie images”) on the front and back surfaces of thecornea and lens.

FIG. 6B shows the pattern 603 a of laser spots on the front surface 114a of the cornea according to the configuration of FIG. 6A. As shown, thepattern 603 a includes thirteen laser spots in this non-limitingexample, corresponding to the thirteen laser beams of array 605. Thepattern 603 a may correspond to either an averaged image of imagingdevices 510 a and 510 b or a differenced image of those imaging devices.The significance of the spacing between spots of the pattern 603 a maydepend on whether the pattern is represented in an averaged image or adifferenced image.

FIG. 6C illustrates the pattern 603 b of laser spots appearing on theback surface 114 b of the cornea. As shown in the non-limiting exampleof FIGS. 6A-6C, the spots of pattern 603 b are more closely spaced thanthose of pattern 603 a. However, not all embodiments are limited in thisrespect. As with FIG. 6B, the pattern 603 b of FIG. 6C may representeither an averaged image or a differenced image of imaging devices.

FIG. 6D illustrates the pattern 603 c of laser spots appearing on thefront surface 116 a of the lens. As shown in FIG. 6A, the array 605 oflaser beams is focused approximately to a point on the front surface 116a of the lens, such that the pattern 603 c includes a single point.Focusing the array 605 approximately to a point on one of the surfacesof interest may facilitate determination of an refractive index of oneof the ocular materials. For example, by knowing where the array isfocused to a point (i.e., the front surface 116 a of the lens in thenon-limiting example of FIG. 6A) and by knowing the distance from thatlocation to a second location at which a pattern of spots appears, thedistances between the spots of the pattern at the second location may beused to determine the refractive index of the material separating thetwo locations. As a non-limiting example, because the array 605 isfocused approximately to a point on the front surface of the lens, thedistances between the spots on the pattern 603 b on the back surface ofthe cornea may be used to determine the refractive index of the aqueousbetween the cornea and the lens by using the distance between the backsurface of the cornea (where the pattern 603 b appears) and the frontsurface of the lens (where the array 605 is focused approximately to apoint). It should be appreciated that the concept of focusing the arrayto a point at a known location is not limited to focusing the array to apoint on a surface of the eye. Rather, according to some embodiments,the array may be focused to a point outside the eye, with the distancefrom the point of focus to a surface of interest on which a pattern oflaser spots appears being known. Also, the focusing of an array of laserbeams may be step-wise or smooth, as the various aspects describedherein are not limited in this respect.

FIG. 6E illustrates the pattern 603 d of laser spots appearing on theback surface 116 b of the lens, corresponding to the configuration ofFIG. 6A. The pattern 603 d may represent an averaged image or adifferenced image of imaging devices.

FIGS. 7A-7E show a different configuration than that of FIGS. 6A-6E, inwhich an array of laser beams is focused on the front surface of thecornea rather than on the front surface of the lens. As shown in FIG.7A, an array 705 of laser beams, including thirteen laser beams in thisnon-limiting example, passes through the condensing lens 612 and isfocused approximately to a point on the front surface 114 a of thecornea. Resulting patterns of laser spots are created as the laser beamscontact the back surface of the cornea, the front surface of the lens,and the back surface of the lens.

FIG. 7B illustrates the pattern 703 a of laser spots appearing on thefront surface 114 a of the cornea for the configuration of FIG. 7A. FIG.7C illustrates the pattern 703 b appearing on the back surface 114 b ofthe cornea for the configuration of FIG. 7A. FIG. 7D illustrates thepattern 703 c of laser spots appearing on the front surface 116 a of thelens for the configuration of FIG. 7A. FIG. 7E illustrates the pattern703 d of laser spots appearing on the back surface 116 b of the lens forthe configuration of FIG. 7A. Any of the patterns 703 a-703 d mayrepresent averaged or differenced images of imaging devices such asimaging devices 510 a and 510 b.

While the apparatus 500 provides one non-limiting example of a suitableapparatus incorporating a laser array source and an interferometer,other apparatus may be used.

According to one embodiment, a Scheimpflug topographer is modified byreplacing the slit beam source of the topographer with a laser array.The techniques described herein for using laser arrays may then be used.According to one embodiment, a Scheimpflug topographer may be modifiedby replacing the slit beam source with a laser array source, and byusing multiple fixed cameras. For example, according to one embodiment,six fixed cameras may be used. Other configurations are also possible.

According to one embodiment, an apparatus utilizing principles of lightfield processing may be used. For example, an apparatus may include alaser source array and one or more light field cameras suitably arrangedto image patterns of spots projected on the eye by the laser sourcearray. Other configurations are also possible.

In addition, it should be appreciated that apparatus such as apparatus500 are not limited to using arrays of lasers. Rather, arrays of anysuitable emission may be used, and lasers represent only one suitablenon-limiting example.

It should be appreciated that the method 200 may be implemented usingthe apparatus 500, or other apparatus that integrate the functionalityof two or more conventional measurement devices. FIGS. 8 and 9illustrate two non-limiting implementations of the method 200 which mayutilize an apparatus such as apparatus 500. FIG. 8 illustrates a methodof determining the shapes and locations of the front and back surfacesof the cornea and lens at a pre-operative stage, similar to the method300 of FIG. 3. Hence apparatus 500 may be coupled physically or by meansof software to any instrument that may be used in method 200. Theseinstruments are not limited to those using Scheimpflug, Purkinje ortime-flight principles (such as topographers or optical coherencetomographers).

FIG. 9 illustrates a method of determining the shapes and locations ofthe front and back surfaces of the cornea and lens at an intra-operativeor post-operative stage, similar to method 400 of FIG. 4.

The method 800 begins at 802 by computing the anterior cornea shape,i.e., the shape of the front surface of the cornea. This may be done byforming an averaged image from images captured by imaging devices 510 aand 510 b of a pattern of laser spots appearing on the front surface ofthe cornea. The averaged image may be compared to the known spacing andarrangement of the lasers of the laser array source (i.e., the spacingand arrangement of the lasers as they exit the laser array source). Fromthe comparison, the shape of the front surface of the cornea may bedetermined.

At 804, multiple parameters whose measured values depend on therefractive index of the cornea may be measured. In the non-limitingexample of FIG. 8, this includes measuring the cornea thickness (at 805a), the distance from the back surface of the cornea to the frontsurface of the lens (at 805 b), the lens thickness (at 805 c), and thedistance from the back surface of the lens to the retina (at 805 d).These measurements may be made using the interferometer source 508, orany other suitable instrument. These measured values may also depend onparameters other than the refractive index of the cornea. For example,the lens thickness and the distance from the back surface of the lens tothe retina may also depend on the refractive index of the lens.

At 806, the posterior cornea shape (i.e., the shape of the back surfaceof the cornea) may be computed by comparing the known spacing andarrangement of the lasers of the laser array source to an averaged imageof a pattern of laser spots appearing on the back surface of the cornea,the averaged image being an average of images of the pattern captured byimaging devices 510 a and 510 b. The computation may take into accountany dependence the images may have on the anterior cornea shape, thecornea thickness, and the refractive index of the cornea. Also at 806,the anterior lens shape (i.e., the shape of the front surface of thelens) may be computed by comparing the known spacing and arrangement ofthe lasers of the laser source array to an averaged image of a patternof laser spots appearing on the front surface of the lens. Thecomputation may take into account any dependence of the images on theanterior cornea shape, cornea thickness, distance from the back surfaceof the cornea to the front surface of the lens, the posterior corneashape, and/or the refractive index of the cornea.

At 808, the refractive index of the cornea may be determined. This maybe done in any suitable manner, including using any of the methodspreviously described with respect to FIGS. 2-4, or any other suitablemanner. According to one embodiment, the refractive index of the corneamay be determined by measuring the cornea thickness using twoalternative techniques, and then reconciling the different valuesproduced by the two techniques to determine the index of refractive. Forexample, the thickness of the cornea may be measured usinginterferometry, and may also be measured by measuring the distancevisually (e.g., using a camera positioned to the side of the eye)between a spot (e.g., a laser spot) on the front of the cornea and aspot (e.g., a laser spot) on the back of the cornea. Reconciling anydifferences between these two values may provide the index of therefraction of the cornea. The refractive index of the cornea may dependon the wavelengths used to measure the cornea thickness (e.g., thewavelengths of the laser beams of the laser array and/or the wavelengthsof the interferometer source), the anterior cornea shape, the corneathickness, and the posterior cornea shape. Thus, the determination ofthe refractive index of the cornea may account for any suchdependencies.

Then, at 810, the values measured at 804 and 806 may be corrected fortheir dependence on the corneal refractive index determined at 808, ifany. One non-limiting manner for doing so is to use the techniquesdescribed in the previously cited reference to Rosales (Scheimpflugquantitative imaging of the crystalline lens and intraocular lens),although other techniques are also possible.

At 812, the total ocular refraction/aberration may be measured. This maybe done in the same manner as described above with respect to FIG. 3, orin any other suitable manner.

At 814, the posterior lens shape (i.e., the shape of the back surface ofthe lens) may be computed by comparing the known spacing and arrangementof the lasers of the laser source array to an averaged image of apattern of laser spots appearing on the back surface of the lens. Theposterior lens shape may depend on the anterior cornea shape, the valuesmeasured at 804, the values computed at 806, the refractive index of thecornea, and/or the total ocular refraction and aberration. Thus, act 814may account for any such dependencies.

At 816, the refractive index of the lens may be determined using adifferenced image of the imaging devices 510 a and 510 b. This may bedone in any suitable manner.

According to one embodiment, the refractive index of the lens may bedetermined using a single spot of the differenced image appearing on thefront of the lens and the corresponding spot (e.g., from the same laserbeam) appearing on the back surface of the lens. The distance betweenthese two spots (again, from the same laser beam) may be determinedusing an imaging device suitably positioned at an angle to the eye. Bymeasuring this distance, and by knowing the angle of the camera and thelaser source relative to the eye, the refractive index of the lens maybe calculated. Other techniques, however, may also be used. Therefractive index of the lens may depend on the wavelengths of the laserarray and the interferometer source, and on all of the parametersdetermined prior to 816. Thus, the determination at 816 may suitablycombine all of the parameters to determine the refractive index of thelens.

An iteration loop comprising acts 814 and 816 may be performed anysuitable number of times. However, the method 800 is not limited toperforming any particular number of iterations.

At 818, the values from 805 c and 805 d may be corrected for theirdependence on the refractive index of the lens. For example, this may bedone using the techniques described in the previously cited reference toRosales (Scheimpflug quantitative imaging of the crystalline lens andintraocular lens), or any other suitable technique. Subsequently, at820, the shapes and locations of the front and back surfaces of thecornea and lens may be determined by suitably combining the previouslydetermined shapes, indices of refraction, and distances/thicknesses. Theact 820 may be performed by any suitable combination of hardware,software, and/or manual calculation, as the method 800 is not limited inthis respect.

FIG. 9 illustrates a method of determining the shapes and locations ofthe front and back surf aces of the cornea and lens of an eye usingapparatus 500 or a similar apparatus. The method 900 of FIG. 9 differsfrom method 800 in that the method 900 be performed in the context of alens implant, thus involving removal of a patient's lens.

The method 900 is the same as method 800 for its first several acts,including acts 802-810. Thus, those acts are not described again indetail here. However, after performing act 810, method 900 continues at912 by measuring the total ocular refraction and aberration, and thedistance from the posterior cornea surface to the retina after removalof the patient's lens, which distance may depend on the refractive indexof the cornea. These measurements may be made in the same manner as themeasurements at act 410 of method 400, or in any other suitable manner.Alternatively, several other separate instruments described above suchas those using Scheimpflug, Purkinje or time-flight principles (such astopographers or optical coherence tomographers) may also be used tomeasure the posterior curvature of the lens in the absence of the lens.

After removal of the patient's lens, fluid may be inserted into the lenscapsule and/or anterior chamber, as previously described with respect toFIG. 4. In some embodiments, the fluid may have a known refractiveindex. At 914, the volume of fluid in the lens capsule and anteriorchamber may be measured using any suitable technique (e.g., a graduatedsyringe, or any other suitable technique).

At 916, the measurements from 912 and 905 d may be repeated with thefluid in the lens capsule and anterior chamber. These measured valuesmay depend on the refractive index of the cornea, the values measured at612, and the refractive index of the fluid. Thus, values measured at 916may be corrected for their dependence, if any, on the refractive indexof the cornea, the values measured at 612, and the refractive index ofthe fluid.

At 918, the posterior lens shape and refractive index of the lens may bedetermined. This determination may performed in any suitable manner. Forexample, the posterior lens shape may be determined from an averagedimage of multiple imaging devices of a pattern of laser spots appearingon the posterior lens, as previously described.

The refractive index may be determined from a differenced image of thepattern of laser spots. The measured values for each of the posteriorlens shape and lens refractive index may be corrected for theirdependence on the other values measured and determined in method 900.For example, the refractive index of the lens may be corrected for allof the previously measured values in method 900 and the wavelengths usedto measure the cornea thickness (e.g., the wavelengths of any one ormore optical methods used for measuring the cornea thickness), accordingto one non-limiting embodiment. The measured posterior lens shape may becorrected for its dependence on the refractive index of the fluidinserted into the lens capsule and anterior chamber, the refractiveindex of the lens, and all of the values from 802-916.

It should be appreciated that 918 may included one or more iterationswithin the act. For example, the determined posterior lens shape maydepend on the refractive index of the lens, and vice versa. Therefore,one or more iterations may be performed in determining these values. At920, the measured values from 805 c and 805 d may be corrected for theirdependence on the refractive index of the lens, if any, in any suitablemanner.

At 922, the values may be combined to model the shapes and locations ofthe front and back surfaces of the cornea and lens. These combinationsmay be performed using a processor (e.g., processor 516), or any othersuitable device. The combinations may involve utilizing ray tracingsoftware in some embodiments.

It should be appreciated that the various methods and apparatusdescribed herein may be used for various applications. For example, raytracing may be used to accurately predict and analyze the operation ofocular components when ocular parameters, such as shapes, indices ofrefraction, and distances are accurately known. Thus, according to someaspects, accurate determination of the indices of refraction, shapes,and ocular distances described above may enable use of ray tracingtechniques to analyze the behavior of the ocular structure. Suchtechniques may avoid any reliance on historical averages of ocularparameters, such as historical averages of indices of refraction.Rather, the techniques described herein may be used to accuratelydetermine ocular parameters for a given patient, allowing accurateapplication of ray tracing analysis to that particular patient's eye.

In addition, the technology described herein may facilitate calculationof the dimensions (i.e., power) of an intraocular lens implant (e.g.,for replacing a cloudy lens (cataract) in eyes that had previous lasercorrective surgery, or for any other reason), and thus may facilitatedesign of customized intraocular lenses. The optical effects of theintraocular lens implant may also be accurately predicted prior tosurgery and analyzed after surgery. For example, the techniquesdescribed herein may facilitate determination of the kinetics of naturalor implanted intraocular lenses based on changes in optics as the lensesmove within an eye. Thus, for example, optical changes resulting frompost-operative wound healing may be calculated. Moreover, according tosome aspects, neural networks (e.g., a computer network that learns fromprior data) may be used to compile databases of average intraocularkinetics and optical changes from wound healing.

Moreover, the techniques described herein may be used to provideimproved accuracy of all types of ophthalmic devices, for example byfacilitating correction of the such devices for their dependency (ifany) on the varying refractive index of an individual's eye.

In addition, the various techniques described herein may facilitateaccurate determination of pupil size. For example, pupil size may bemeasured and then accurate values of corneal topography and the cornealrefractive index, determined by any of the techniques previouslydescribed, may be used to correct the measured pupil size to produce amore accurate determination of pupil size. Accurately knowing the pupilsize may facilitate ocular modeling (e.g., only rays entering the pupilmay be considered in some embodiments), modeling of diffraction,simulating vision, calculating aberration, etc.

As has been described, ray tracing software may be used in variousembodiments, and may facilitate prediction and analysis of opticalbehavior within the eye. For example, simulations of the opticalbehavior within the eye may be performed and represented visually on adisplay screen (e.g., a computer screen) in the form of reducedSnellen/Landolt C/ETDRS vision or pictures. Other forms of visualrepresentation are also possible. Surgeons may use such visuals toanalyze optical behavior, and the visuals may assist in selection of anappropriate surgery (e.g., presbyopic LASIK, concutive keratoplasty,etc.) and/or an appropriate implant (e.g., bifocal intraocular lens,etc.). According to some embodiments, the ray tracing software may beused to simulate wavefront refraction and wavefront aberration of an eyeprior to surgery.

According to one aspect, ray tracing may be used to determinedifferences in the index of the refraction with the cornea and/or lens.For example, the lens may be made up of zones of differing density(known as gradient index, or “GRIN”), which may be accurately modeledray tracing. The techniques described herein may utilize compositeindices of refraction of the cornea and lens in some embodiments, but inother embodiments may use indices of refraction that vary within thesestructures.

According to one aspect of the technology described herein, a method fordetermining the effective position of a lens is provided. Natural lensesand lens implants often differ in shape. When performing a lensreplacement, it may be desirable to position the lens implantsubstantially at the same location as that at which the natural lens waspositioned. Because the shapes of the natural lens and lens implant maydiffer, it may be difficult to position the front and back surfaces ofthe implant at the same locations at which the front and back surfacesof the natural lens were positioned within the eye. Thus, according toone aspect, an “effective position” of the natural lens may bedetermined, and may be used as the desired placement of the lensimplant. An example is described with respect to FIG. 10.

FIG. 10 illustrates a non-limiting example of a cross-section of anatural lens. The lens has an anterior surface 1002 a and a posteriorsurface 1002 b. If the lens is to be removed during lens replacementsurgery, it may be desirable to know where to position the replacementlens, which may not take the shape shown in FIG. 10. Various methods ofdetermining an “effective position” of the lens may be used. Forexample, according to one embodiment, the effective lens position iscalculated using the position of the lens as determined byinterferometry in an un-dilated pupil state.

According to another embodiment, the “effective position” of the lensmay be determined by extrapolating the topographies of the anterior andposterior lens surfaces 1002 a and 1002 b. The point at which these twotopographies meet may be considered a presumptive equator of the lens,and the ratio of the that point to the apex of the anterior and posterlens surfaces may be used as the effective lens position, shown as point1 in FIG. 10.

According to another embodiment, the effective lens position may bedetermined by first obtaining a diameter of the lens in any suitablemanner (e.g., using ultrasound, using the volume of fluid inserted intothe lens capsule, or any other suitable manner), and then extrapolatingthe anterior and posterior lens surfaces to the diameter. The midpointof the arc length of the lens may then be used as the effective lensposition, shown as point 2 in FIG. 10.

According to another embodiment, simulated topography of the posteriorlens surface may be used to determine the effective position of thelens. The simulated posterior topography may be obtained byapproximating a best-fit curve for posterior topography using anteriorlens topography, lens thickness, and a historical ratio between theanterior and posterior lens curvatures. The resulting effective lensposition may be represented by point 3 in FIG. 10. Once the effectivelocation of the lens is determined (whether being point 1, point 2, orpoint 3), a replacement lens may be positioned at substantially the samelocation.

Regression analysis of any of the previously described method fordetermining the effective location of the lens may be used to increaseaccuracy of the results. Also, one or more of the techniques describedpreviously herein may be used to facilitate the determination ofeffective lens position. For example, low/partial coherenceinterferometry may be performed after removal of the natural lens toobtain distances in the absence of the lens.

Ray tracing may be used to determine shapes, indices of refraction,and/or distances in the absence of the lens. Pre-operative andintra-operative measurements of topography and interferometry may beused to increase accuracy of measurements and calculated positions, forexample by providing additional information for use in iteration loopsof any of the methods described above.

According to one embodiment, stretch or elasticity coefficients may bedetermined, and may facilitate lens design and/or determining thelocation of lens implants.

For example, lens capsule elasticity may be used to predict the finalpositioning of a lens after insertion in into the lens capsule. Theelasticity coefficients may be determined using lens dimension data,patient age, and thickness of the lens capsule, among otherconsiderations. Elasticity of a lens implant may similarly beconsidered.

It should be appreciated that various techniques described herein maytherefore be used to design lenses, for example including lens implants.The techniques may apply to designing various types of lenses,including, but not limited to, plano, convex, concave, multifocal(refractive, diffractive, etc.), toric, accommodative, prismatic,multiple lens configurations, variable curvature (e.g., aspherical),phakic intraocular lenses, light adjustable lenses, or any combinationof those listed.

Additionally, one or more of the techniques described herein may be usedin the context of planning or performing various types of surgeries.Such surgeries may include, but are not limited to, cornea/refractivesurgery, lens surgery and retinal surgery. Various types of refractivesurgery may include, but are not limited to, myopic, hyperopic andpresbyopic LASIK, LASEK, or PRK, conductive keratoplasty, radialkeratotomy or a combination of the above.

It should be appreciated that the various aspects described above arenot limited to human eyes, but rather may be applied to any type of eye,including human eyes or any other animals. In addition, while variousaspects have been described as relating to structures of the eye andimplants for the eye, it should be appreciated that the techniques mayalso apply to additional elements, such as glasses, contact lenses, orother elements used for ocular purposes

As previously mentioned, it should be appreciated that the methods andapparatus described above may be used to form a model of any number ofstructures of interest within an eye. For example, according to someembodiments, a complete model of the eye may be formed. In otherembodiments, a model of a single structure (e.g., the lens, or a surfaceof the lens) may be formed. In still other embodiments, the methodsand/or apparatus described above may be used to determine a singleparameter of interest of a structure.

Thus, individual acts of the methods described above may be used forsome applications, irrespective of whether the other acts are alsoperformed.

The above-described embodiments of the present technology can beimplemented in any of numerous ways. For example, the embodiments may beimplemented using hardware, software or a combination thereof. Whenimplemented in software, the software code can be executed on anysuitable processor or collection of processors, whether provided in asingle computer or distributed among multiple computers. It should beappreciated that any component or collection of components that performthe functions described above can be generically considered as one ormore controllers that control the above-discussed functions. The one ormore controllers can be implemented in numerous ways, such as withdedicated hardware, or with general purpose hardware (e.g., one or moreprocessors) that is programmed using microcode or software to performthe functions recited above. In this respect, it should be appreciatedthat one implementation of the embodiments of the present technologycomprises at least one computer-readable storage medium (e.g., acomputer memory, a floppy disk, a compact disk, a tape, a flash drive,etc.) encoded with a computer program (i.e., a plurality ofinstructions), which, when executed on a processor, performs theabove-discussed functions of the embodiments of the present technology.The computer-readable storage medium can be transportable such that theprogram stored thereon can be loaded onto any computer resource toimplement the aspects of the present technology discussed herein. Inaddition, it should be appreciated that the reference to a computerprogram which, when executed, performs the above-discussed functions, isnot limited to an application program running on a host computer.Rather, the term computer program is used herein in a generic sense toreference any type of computer code (e.g., software or microcode) thatcan be employed to program a processor to implement the above-discussedaspects of the technology.

While various inventive embodiments have been described and illustratedherein, those of ordinary skill in the art will readily envision avariety of other means and/or structure for performing the functionand/or obtaining the results and/or one or more of the advantagesdescribed herein, and each of such variations and/or modifications isdeemed to be within the scope of the inventive embodiments describedherein. Those skilled in the art will recognize, or be able to ascertainusing no more than routine experimentation, many equivalents to thespecific inventive embodiments described herein. It is, therefore, to beunderstood that the foregoing embodiments are presented by way ofexample only and that, within the scope of the appended claims andequivalents thereto, inventive embodiments may be practiced otherwisethan as specifically described and claimed. Inventive embodiments of thepresent technology are directed to each individual feature, system,article, material, kit, and/or method described herein. In addition, anycombination of two or more such features, systems, articles, materials,kits, and/or methods, if such features, systems, articles, materials,kits, and/or methods are not mutually inconsistence, is included withinthe inventive scope of the present disclosure. All definitions, asdefined and used herein, should be understood to control over dictionarydefinitions, definitions in documents incorporated by reference, and/orordinary meanings of the defined terms. The indefinite articles “a” and“an,” as used herein in the specification and in the claims, unlessclearly indicated to the contrary, should be understood to mean “atleast one.” The phrase “and/or,” as used herein in the specification andin the claims, should be understood to mean “either or both” of theelements so conjoined, i.e., elements that are conjunctively present insome cases and disjunctively present in other cases. Multiple elementslisted with “and/or” should be construed in the same fashion, i.e., “oneor more” of the elements so conjoined. Other elements may optionally bepresent other than the elements specifically identified by the “and/or”clause, whether related or unrelated to those elements specificallyidentified. Thus, as a non-limiting example, a reference to “A and/orB”, when used in conjunction with open-ended language such as“comprising” can refer, in one embodiment, to A only (optionallyincluding elements other than B); in another embodiment, to B only(optionally including elements other than A); in yet another embodiment,to both A and B (optionally including other elements); etc. As usedherein in the specification and in the claims, “or” should be understoodto have the same meaning as “and/or” as defined above. For example, whenseparating items in a list, “or” or “and/or” shall be interpreted asbeing inclusive, i.e., the inclusion of at least one, but also includingmore than one, of a number or list of elements, and, optionally,additional unlisted items. Only terms clearly indicated to the contrary,such as “only one of” or “exactly one of,” or, when used in the claims,“consisting of,” will refer to the inclusion of exactly one element of anumber or list of elements. In general, the term “or” as used hereinshall only be interpreted as indicating exclusive alternative (i.e.,“one or the other but not both”) when preceded by terms of exclusivity,such as “either,” “one of,” “only one of,” or “exactly one of”“Consisting essentially of,” when used in the claims, shall have itsordinary meaning as used in the field of patent law. As used herein thespecification and in the claims, the phrase “at least one,” in referenceto a list of one or more elements, should be understood to mean at leastone element selected from any one or more of the elements in the list ofelements, but not necessarily including at least one of each and everyelement specifically listed within the list of elements and notexcluding any combinations of elements in the list of elements. Thisdefinition also allows that elements may optionally be present otherthan the elements specifically identified within the list of elements towhich the phrase “at least one” refers, whether related or unrelated tothose elements specifically identified. Thus, as a nonlimiting example,“at least one of A and B” (or, equivalently, “at least one of A or B,”or, equivalently “at least one of A and/or B”) can refer, in oneembodiment, to at least one, optionally including more than one, A, withno B present (and optionally including elements other than B); inanother embodiment, to at least one, optionally including more than one,B, with no A present (and optionally including elements other than A);in yet another embodiment, to at least one, optionally including morethan one, A, and at least one, optionally including more than, B (andoptionally including other elements); etc. It should also be understoodthat, unless clearly indicated to the contrary, in any methods claimedherein that include more than one step or act, the order of the steps oracts of the method is not necessarily limited to the order in which thesteps or acts of the method are recited. In the claims, as well as inthe specification above, all transitional phrases such as “comprising,”“including,” “carrying,” “having,” “containing,” “involving,” “holding,”“composed of,” and the like are to be understood to be open-ended, i.e.,to mean including but not limited to. Only the transitional phrases“consisting of” and “consisting essentially of” shall be closed orsemi-closed transitional phrases, respectively, as set forth in theUnited States Patent Office Manual of Patent Examining Procedures,Section 2111.03.

The words “comprises/comprising” and the words “having/including” whenused herein with reference to the present invention are used to specifythe presence of stated features, integers, steps or components but doesnot preclude the presence or addition of one or more other features,integers, steps, components or groups thereof. It is appreciated thatcertain features of the invention, which are, for clarity, described inthe context of separate embodiments, may also be provided in combinationin a single embodiment. Conversely, various features of the inventionwhich are, for brevity, described in the context of a single embodiment,may also be provided separately or in any suitable sub-combination.

1.-41. (canceled)
 42. A method of modeling a lens of an eye having acornea, the method comprising: performing a first type of direct opticalmeasurement of a first parameter of the cornea and performing a secondtype of direct optical measurement of a second parameter of the cornea;performing the first type of direct optical measurement of a firstparameter of the lens and performing the second type of direct opticalmeasurement of a second parameter of the lens; determining from thefirst and second parameters of the cornea and the first and secondparameters of the lens a third parameter of the cornea; correcting thefirst and second types of direct optical measurements of the first andsecond parameters of the cornea and the first and second parameters ofthe lens to form corrected measurements of the first and secondparameters of the cornea and the first and second parameters of the lensby accounting for an effect of the third parameter of the cornea on thefirst and second type of direct optical measurements of the first andsecond parameters of the cornea and the first and second parameters ofthe lens; calculating a third parameter of the lens by combining thecorrected first and second types of direct optical measurements of thefirst and second parameters of the cornea and first and secondparameters of the lens; and correcting the first and second types ofdirect optical measurements of the first and second parameters of thecornea and the first and second parameters of the lens to account forthe effect of the third parameter of the lens on the direct opticalmeasurements of the first and second parameters of the cornea and thefirst and second parameters of the lens.
 43. The method of claim 42wherein the first type of direct optical measurement and the second typeof direct optical measurement are selected from the group consisting of:topography, refractometry, and interferometery.
 44. The method of claim42 wherein the first and second parameters of the cornea is selectedfrom the group consisting of: cornea thickness, a posterior cornea shapeand a distance from a back of the cornea to a front of the lens;
 45. Themethod of claim 42 wherein the first and second parameters of the lensis selected from the group consisting of: an anterior lens shape, aposterior lens shape, a lens thickness and a distance from a back oflens to a retina of the eye.
 46. The method of claim 42 wherein arefractive index of the cornea is determined by a refractometer.
 47. Themethod of claim 42 wherein a refractive index of the cornea isdetermined by combining the first and second direct optical measurementsof the first and second parameters of the cornea of the eye.
 48. Themethod of claim 42 wherein the first and second types of direct opticalmeasurements measure at least one of: a total ocular refraction andaberration in the absence of the lens; a total volume of aqueous; atotal refraction and aberration with fluid in a lens capsule and ananterior chamber of the eye; or and a distance from the back of thecornea to the retina as measured in the absence of the lens.
 49. Themethod of claim 42, wherein at least one of a refractive index of thecornea, a refractive index of the lens, an anterior and a posteriorshape of the cornea, and an anterior and a posterior shape of the lensis measured using a laser array source comprising one or more lasers.50. The method of claim 49 wherein measuring the anterior or posteriorshape of the cornea comprises: capturing one or more images of a patternof laser spots generated on the anterior surface or the posteriorsurface of the cornea by the laser array source; forming an averagedimage from the captured images; and comparing the averaged image to aspacing and an arrangement of the lasers of the laser array source. 51.The method of claim 49, wherein measuring the anterior or posterior lensshape comprises: capturing one or more images of a pattern of laserspots generated on the anterior or posterior surface of the lens by thelaser array source; forming an averaged image from the captured images;and comparing the averaged image to a spacing and an arrangement of thelasers of the laser array source.
 52. The method of claim 51, furthercomprising: forming laser spots on both the anterior and posterior lenssurfaces, and wherein the refractive index of the lens is determinedusing a difference image determined using the laser spot appearing onthe anterior of the lens and the laser spot appearing on the posteriorof the lens.
 53. A method of determining an optimum position for areplacement intraocular lens based on an effective position of a naturallens having an anterior surface and a posterior surface, the methodcomprising: modeling the natural lens using the method of claim 1 todetermine the anterior and posterior surfaces of the natural lens;extrapolating the anterior and posterior surfaces to cross points; anddetermining the optimum position defined by a line joining said crosspoints.
 54. A method of determining an optimum position for areplacement intraocular lens based on an effective position of thenatural lens having an anterior surface and a posterior surface, themethod comprising: modeling the natural lens using the method of claim 1to determine the anterior and posterior surfaces of the natural lens;determining a diameter of the natural lens; extrapolating the anteriorand posterior lens surfaces to the diameter; determining an arc lengthof the natural lens using the diameter; and determining the optimumposition to lie at the midpoint of the arc length.
 55. A method ofdetermining an optimum position for a replacement intraocular lens basedon an effective position of a natural lens having an anterior surfaceand a posterior surface, the method comprising: modeling the naturallens using the method of claim 1 to determine the anterior and posteriorsurfaces of the natural lens; and approximating a best fit curve for theposterior surface using the anterior lens surface, the lens thicknessand a historical ratio between the anterior and posterior lenscurvatures.